- Humana (Austin, TX)
- …you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ ... To succeed in this position, you will need to be well versed in CMS knowledge of outpatient, inpatient and appeal criteria including regulation and policies. You… more
- Molina Healthcare (Houston, TX)
- …the RADV (Risk Adjustment Data Validation) team, assisting in the execution of CMS and internal audit activities. This position contributes to the development of ... the generation of chart retrieval chase lists based on CMS audit samples and internal data logic. + Use...ensure accurate and consistent data interpretation. + Help translate CMS audit requirements into data tasks under the guidance… more
- Molina Healthcare (San Antonio, TX)
- …Validation) team, contributing to the end-to-end data strategy and execution of CMS and internal audit activities. This position is responsible for supporting RADV ... + Support RADV audit execution by identifying appropriate data sources, validating CMS audit samples, and generating chart retrieval chase lists in coordination with… more
- Houston Methodist (Houston, TX)
- … CMS , and Medicaid to ensure proper department financial management , compliance with all governmental reporting requirements, and proper quality outcomes ... recipient transplantation. Primary responsibilities for this position include logistics management , preservation, packaging and labeling of organs for transplantation;… more
- Highmark Health (Austin, TX)
- …Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, state, CMS ... departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes...not limited to NIST, HITRUST, PCI, HIPAA, SOC, MAR, CMS , JCAHO, in order to identify, assess, prioritize, evaluate… more
- Houston Methodist (Houston, TX)
- …order sets, policies, and other documentation. Monitors outcomes of current policy, process/ system changes and reports variances to appropriate management and ... quality and accreditation team members to ensure the regulatory compliance with CMS Conditions of Participation for Transplant Centers, United Network of Organ… more
- CVS Health (Austin, TX)
- …codes that are submitted to the Centers for Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes are appropriate, accurate, and ... process audits to ensure compliance with internal policies and procedures and existing CMS regulations. + Ability to work independently as well as in a cross… more
- Insight Global (Plano, TX)
- …include our secure Salesforce Experience Cloudbased client portal and integrated content delivery systems powered by Azure-native infrastructure. This role is ideal ... implement end-to-end solutions using Azure-native services such as Azure Functions, API Management , Blob Storage, Cosmos DB, and Event Grid. - Develop scalable and… more
- Siemens (Irving, TX)
- …CSC consists of a customer support center and a Central Monitoring Station ( CMS ). The IT Partner Manager will maintain the sophisticated IT architecture that powers ... experience as an IT professional in a Central Monitoring Station ( CMS ) environment, with expert knowledge of signals receivers, concentrators, switches, servers,… more
- Elevance Health (Houston, TX)
- …position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of ... : + Degree in Accounting preferred. + Knowledge of CMS program regulations and cost report format preferred. +...regulations and cost report format preferred. + Knowledge of CMS computer systems and Microsoft Office Word and Excel… more